Stefanie Singer and Brandie Salisbury.
Fluoroquinolones
By: Stefanie
Singer RN &
Brandie
Salisbury RN
What are Fluoroquinolones (FQs)?
Broad spectrum antibiotics that exhibit
bactericidal activity with many gram negative and gram positive bacteria.
Mechanism of Action
FQs
interfere with DNA gyrase, and enzyme needed for bacterial DNA synthesis.
Examples
§
ciprofloxacin
HCI (Cipro)
§
levofloxacin (Levaquin)
§
lomefloxacin (Maxaquin)
§
moxifloxacin (Avelox)
§
norfloxacin (Noroxin)
§
ofloxacin (Floxin)
Drug and Supplement Interactions:
§
Calcium and antacids
§
Caffeine
§
Theophylline
§
Oral
hypoglycemics
§
Iron
Uses/Indications
§
Urinary Tract
Infection
§
Bone &
Joint Infection
§
Bronchitis
§
Pneumonia
§
Gastroenteritis
§
Gonorrhea
§
Prostatitis
§
Skin
Infections
§
Anthrax
Side Effects:
§ Nausea
§ Vomiting
§ Diarrhea
§ Abdominal
cramps
§ Flatulence
§ Headache
§ Dizziness
§ Fatigue
§ Restlessness
§ Insomnia
§ Rash
§ Flushing
§ Tinnitus
§ Photosensitivity
Nursing Considerations/Patient Teaching
§ Record vital
signs and urine intake/output.
§ Assess lab
results for renal function: BUN & Creatinine
§ Obtain drug
& diet history.
§ Antacids and iron decrease absorption of FQs.
§ Teach patient
to drink 6-8 glasses fluids daily.
§ Encourage
patient to avoid caffeine.
§ Avoid operating
machinery and motor vehicle while taking this drug.
§ FQs can exacerbate Myasthenia Gravis. If you have MG, be sure your provider is aware.
Rare Risk
FQs
have the ability to penetrate the blood-brain barrier and can cause rare
neurological problems such as seizures, toxic psychosis, suicidal ideation,
confusion, encephalopathy, and tremors.
Rare Risk
Cipro
and other FQs are associated with an increased risk of tendon rupture,
particularly the Achilles tendon. This
risk is increased when the patient is above age 60 and with patients on
cortisone therapy. FQs have a black box warning regarding this.
References
Kee,
J. L., Hayes, E. R., & McCuistion, L. E. (2012). Pharmacology: A nursing
process approach. St. Louis: Elsevier Saunders.
Pantalone,
A., Abate, M., D’Ovidio, C., Carnevale, A., & Salini, V. (2011) Diagnostic failure of ciprofloxacin-induced spontaneous
bilateral Achilles tendon rupture: case-report and medical-legal
considerations. International
Journal Of Immunopathology And Pharmacology,
24(2). 519-522.
Pharmacist: How common is the tendon rupture? It sounds pretty serious, yet so many people take Cipro. I read one piece of info that said the risk lasts up to a year. Is that true?
ReplyDeleteStefnaie and Brandie
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116919.htm
ReplyDeleteTendon rupture is not common at all but advising those over 60 of the signs/symptoms is key. Broad spectrum drugs should be saved for when they are appropriate. I have not heard of the risk lasting up to a year. It doesn't mention it in the FDA alert on the topic but maybe there is more data that I'm not familiar with.